Hospital practice (1995)
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Hospital practice (1995) · Aug 2014
ReviewManagement of acute coronary syndrome in the hospital: a focus on ACCF/AHA guideline updates to oral antiplatelet therapy.
The 3 main clinical manifestations of acute coronary syndrome (ACS) are unstable angina, non-ST-segment myocardial infarction, and ST-segment myocardial infarction. Together they comprise a major cause of emergency care and hospitalization in the United States. Consequently, all hospital-based physicians should be familiar with current recommendations regarding the diagnosis and management of ACS. ⋯ Among the P2Y12 inhibitors recommended for each indication, the guidelines do not advocate any one P2Y12 inhibitor over another, but instead recommend that therapy is individualized based on each patient's demographic and clinical characteristics. This article presents a clinical case study to illustrate the hospital management of ST-segment myocardial infarction and unstable angina/non-ST-segment myocardial infarction with particular reference to the latest changes in antiplatelet therapy guidelines. This article outlines key differences in the indications and recommendations for P2Y12 inhibitors and summarizes clinical data from the pivotal studies of prasugrel and ticagrelor.
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Hospital practice (1995) · Aug 2014
ReviewCanagliflozin, a sodium glucose co-transporter 2 inhibitor, for the management of type 2 diabetes.
The kidney plays a key role in glucose homeostasis and the pathophysiology of type 2 diabetes mellitus (T2DM). Sodium glucose co-transporter 2 (SGLT2) inhibitors are a new class of antihyperglycemic agents for the treatment of T2DM with a novel insulin-independent mechanism of action that targets the kidney. ⋯ Canagliflozin is generally well tolerated, with increased incidences of specific adverse events that are related to the mechanism of SGLT2 inhibition. Findings suggest that canagliflozin is a useful treatment option for patients with T2DM.
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Hospital practice (1995) · Aug 2014
ReviewTarget-specific oral anticoagulants: practice issues for the clinician.
Venous thromboembolism and atrial fibrillation are among the most common cardiovascular disorders in the United States. For over 50 years, the standard of care has been anticoagulation with vitamin K antagonists. ⋯ Dabigatran, rivaroxaban, apixaban, and edoxaban have been shown to be as effective as warfarin in the treatment and prevention of venous thromboembolism and prevention of stroke in nonvalvular atrial fibrillation. This article compares the basic pharmacologic properties of these anticoagulants, reviews the data supporting their use, and discusses practical clinical issues including measurement of the anticoagulation effect, reversal strategies, and management of patients prior to surgery.
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Hospital practice (1995) · Aug 2014
A cost analysis of the impact of a new intravenous antihypertensive in managing perioperative blood pressure during cardiac surgery.
To examine the impact of intravenous antihypertensive selection on hospital health resource utilization using data from the Evaluation of CLevidipine In the Perioperative Treatment of Hypertension Assessing Safety Events (ECLIPSE) trials. ⋯ Health resource utilization across therapeutic alternatives can be derived from an analysis of standard costs from hospital financial data to matched utilization metrics as part of a randomized controlled trial. In cardiac surgical patients, intravenous antihypertensive selection was associated with a shorter time to extubation in the ICU and a shorter ICU stay compared with pooled comparators, which in turn may decrease total costs.